title: Retrospective analysis of acute fatty liver of pregnancy: twenty-eight cases and discussion of anesthesia.
abstract: OBJECTIVE
  To summarize the clinical features, perioperative management and maternal and neonatal outcomes of patients with acute fatty liver of pregnancy (AFLP) and to discuss the management of anesthesia in these patients.
  
  
  METHODS
  This study was a retrospective review over a period of 5 years and 9 months; 28 cases from the Shanghai Public Health Clinical Center were included. Records were reviewed for symptoms, signs, laboratory findings, clinical courses, perioperative management and maternal and neonatal outcomes.
  
  
  RESULTS
  Of the AFLP cases analyzed in the present study, 75.0% occurred in primipara and 63.3% occurred with male fetuses. Prodromic symptoms included the sudden onset of fatigue, nausea, vomiting, anorexia and jaundice. Laboratory results indicated liver function abnormalities, coagulopathy, hypoglycemia, leukocytosis and negative urine bilirubin. There were 2 maternal deaths (7.1%) without fetal deaths. Cesarean sections were performed in 16 cases under neuraxial anesthesia and in 12 cases under general anesthesia with rapid-sequence induction.
  
  
  CONCLUSIONS
  Early diagnosis, prompt delivery and intensive supportive treatment are critical for improving the prognosis of AFLP. Anesthesia selection should be individualized and general anesthesia with rapid-sequence induction may be the best choice for patients with severe coagulopathy.
authors.affiliation: Department of Anesthesia, Zhongshan Hospital and Department of Anesthesiology, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: GuoXia
authors.initials: G
authors.lastname: Zhou
authors.forename: XiaoHong
authors.initials: X
authors.lastname: Zhang
authors.forename: ShengJin
authors.initials: S
authors.lastname: Ge
mesh_terms: D000328:Adult; D000758:Anesthesia; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal; D002585:Cesarean Section; D004211:Disseminated Intravascular Coagulation / Q000209:etiology; D005234:Fatty Liver / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology; D007019:Hypoproteinemia / Q000209:etiology; D007231:Infant, Newborn; D007964:Leukocytosis / Q000209:etiology; D008297:Male; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000628:therapy*; D011256:Pregnancy Outcome; D051437:Renal Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D055815:Young Adult